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Vascular morphology: (A) B-mode image of a mouse heart acquired from 2D echocardiography showing the left ventricle in a parasternal long axis view, apex pointing to the left and aorta to the right. The boxes illustrates the areas of the ascending aorta used for measurements of wall thickness. RW right-side wall, LW left-side wall. (B,C) Wall thickness measured on the RW and LW of the ascending aorta after 14 days of testosterone exposure. Testosterone treated animals = AAS (N = 20), sham operated animals = Ctrl (N = 20). Data presented with median.
Source publication
High-doses of anabolic–androgenic steroids (AAS) is efficient for building muscle mass, but pose a risk of cardiovascular side effects. Little is known of the effect of AAS on vasculature, but previous findings suggest unfavorable alterations in vessel walls and vasoreactivity. Here, long-term effect of AAS on vascular function and morphology were...
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Background:
Previous studies have established normal and reference values for Pulse Wave Velocity (PWV). However, the PWV value that has the strongest association with cardiovascular biomarkers remains poorly understood.
Objective:
This study aimed to determine the PWV value more likely to be associated with left ventricular hypertrophy (LVH), i...
Citations
... The participants were recruited from this project, and the sample is partly overlapping with the one described in previous brain health publications. 16,19,20 A self-reported one repetition maximum (1RM) bench press of at least 100 kg (∼220 lbs) was required to enter the study. The participants were either current or former (defined as at least 1 year since cessation of AAS use) AAS users reporting at least 1 year of cumulative AAS use or men who had never been exposed to AAS or equivalent doping substances (WLC). ...
Aims
This study aims to explore the cardiovascular effects of long-term anabolic–androgenic steroid (AAS) use in both current and former weightlifting AAS users and estimate the occurrence of severe reduced myocardial function and the impact of duration and amount of AAS.
Methods and results
In this cross-sectional study, 101 weightlifting AAS users with at least 1 year cumulative AAS use (mean 11 ± 7 accumulated years of AAS use) were compared with 71 non-using weightlifting controls (WLC) using clinical data and echocardiography. Sixty-nine were current, 30 former (>1 year since quitted), and 2 AAS users were not available for this classification. Anabolic–androgenic users had higher left ventricular mass index (LVMI) (106 ± 26 vs. 80 ± 15 g/m2, P < 0.001), worse left ventricular ejection fraction (LVEF) (49 ±7 vs. 59 ± 5%, P < 0.001) and right ventricular global longitudinal strain (−17.3 ± 3.5 vs. −22.8 ± 2.0%, P < 0.001), and higher systolic blood pressure (141 ± 17 vs. 133 ± 11 mmHg, P < 0.001) compared with WLC. In current users, accumulated duration of AAS use was 12 ± 7 years and in former 9 ± 6 years (quitted 6 ± 6 years earlier). Compared with WLC, LVMI and LVEF were pathological in current and former users (P < 0.05) with equal distribution of severely reduced myocardial function (LVEF ≤40%) (11 vs. 10%, not significant (NS)). In current users, estimated lifetime AAS dose correlated with reduced LVEF and LVGLS, P < 0.05, but not with LVMI, P = 0.12. Regression analyses of the total population showed that the strongest determinant of reduced LVEF was not coexisting strength training or hypertension but history of AAS use (β −0.53, P < 0.001).
Conclusion
Long-term AAS users showed severely biventricular cardiomyopathy. The reduced systolic function was also found upon discontinued use.
... In the 2018 ESC/ESH clinical practice guidelines for the management of arterial hypertension, AAS abuse is listed as one of the causes for resistant hypertension. (9,(15)(16)(17) In a 2022 position paper on the cardiovascular effects of doping substances, it is still unclear whether pathological myocardial hypertrophy is attributed to arterial hypertension or to the direct effect of AAS on the myocardium. (18) In this large scale cross-sectional study we explored the long-term effects of supraphysiological AAS-doses on myocardial hypertrophy and myocardial function, and if a substantial proportion of the users develop severely reduced myocardial function, by comparing current and former AAS-using weightlifters with a non-using weightlifting control (WLC) cohort, employing echocardiographic imaging techniques. ...
... The participants were recruited from this project, and the sample is partly overlapping with the one described in previous brain health publications. (16,19,20) A self-reported one repetition maximum (1RM) bench press of at least 100 kg (approximately 220 lbs) was required to enter the study. The participants were either current or former (defined as at least one year since cessation of AAS-use) AAS-users reporting at least one year of cumulative AAS-use, or men who had never been exposed to AAS or equivalent doping substances (weightlifting controls, WLC). ...
Aims
Explore the cardiovascular effects of long-term anabolic-androgenic steroid (AAS)-use in both current and former weightlifting AAS-users, and estimate the occurrence of severe reduced myocardial function and the impact of duration and amount of AAS.
Methods
In this cross-sectional study 101 weightlifting AAS-users with at least one year cumulative AAS-use (mean 11±7 accumulated years of AAS-use) were compared to 71 non-using weightlifting controls (WLC) using clinical data and echocardiography.
Results
Sixty-nine were current, 30 former (> 1 year since quitted), and 2 AAS-users were not available for this classification. AAS-users had higher left ventricular mass index (LVMI) (106±26 versus 80±15 g/m ² , P<0.001), worse LV ejection fraction (LVEF) (49±7 versus 59±5%, P<0.001) and right ventricular global longitudinal strain (RVGLS) (−17.3±3.5 versus −22.8±2.0%, P<0.001), and higher systolic blood pressure (SBP) (141±17 vs. 133±11 mmHg, p<0.001) compared with WLC. In current users accumulated duration of AAS-use was 12±7 years, and in former 9±6 years (quitted 6±6 years earlier). Compared to WLC, LVMI and LVEF were pathological in current and former users (p<0.05) with equal distribution of severely reduced myocardial function (LVEF ≤40%) (11% vs. 10%, NS). In current users estimated life time AAS-dose correlated with reduced LVEF and LVGLS, p<0.05, but not with LVMI, p=0.12. Regression analyses of the total population showed that the strongest determinant of reduced LVEF were not coexisting strength training or hypertension, but history of AAS-use (β −0.53, P<0.001).
Conclusions
Long-term AAS-users showed severely biventricular cardiomyopathy. The reduced systolic function was also found upon discountied use.
... anabolic-androgenic steroids (aas) constitute a sub-group of image and performance enhancing drugs (iPeDs), designed to mimic the effects of endogenous testosterone (Kicman, 2008). in recent decades, the use of aas has become increasingly more common in the general population, especially among young men, to boost muscle strength and to improve aesthetics and performance (Brennan et al., 2017). however, aas use is associated with multiple bodily harms, including endocrine, cardiovascular and metabolic disturbances (horwitz et al., 2019;Melsom et al., 2022;Pope et al., 2014;Rasmussen, schou, Madsen, selmer, Johansen, hovind, et al., 2018;Rasmussen et al., 2017), as well as reduced cognition, risk behavior and other substance use (Bjornebekk et al., 2019;havnes et al., 2020;Zahnow et al., 2018). aas-induced hypogonadism (asih), which is caused by aas' long term feedback inhibition on the hypothalamic-pituitary-gonadal (hPG) axis, commonly leads to distressing withdrawal symptoms among those who try to cease use (Botman et al., 2023;de Ronde & smit, 2020;Rahnema et al., 2014). ...
... 5 Adverse effects of AAS usage include secretion suppression of gonadotropins, neuropsychiatric effects, dyslipidemia, hypertension, arrhythmia, erythrocytosis, 5 and decreased arterial plasticity. 6 This report summarizes an instance of ischemic stroke in a young male who reported using both stanozolol and clenbuterol in preparation for a bodybuilding contest. Written, informed consent was obtained for the publication of this report. ...
... 7 In addition to its atherogenic effects, excess LDL-C may oxidize at the arterial endothelium and impair endothelium-dependent arterial relaxation by inhibiting nitric oxide production, predisposing the patient to vasospasm. 6,8 Concurrently, the effect of AAS abuse on the hemostatic system may alternate from an antithrombotic to a prothrombotic state. This results in abnormally high thrombin-antithrombin complexes in the plasma, higher concentrations of plasma fibrinogen, plasminogen, and plasmin inhibitor, and a reduction in fibrin clot lysis, potentially causing a procoagulant state. ...
... Prevalence estimates suggest that around 3-6% of young men in most Western countries have used AAS (Kanayama et al., 2010;Pope, Kanayama, et al., 2014;Pope, Wood, et al., 2014;Sagoe et al., 2014), typically in supraphysiologic doses, thus, increasing the risk of potential side-effects (Pope, Wood, et al., 2014). These range from acne, sleep disturbances, and gynecomastia (Ip et al., 2011;Parkinson & Evans, 2006) to more serious complications such as cardiovascular effects (Baggish et al., 2017;Melsom et al., 2022;Thiblin et al., 2015), prolonged hypogonadism Rasmussen et al., 2016), poorer cognitive performance (Bjørnebekk et al., 2019;Kanayama et al., 2013), and brain structural and functional abnormalities Pope et al., 2021;Scarth & Bjørnebekk, 2021;Westlye et al., 2017). ...
Introduction:
Prior research has demonstrated that personality disorders and clinical psychiatric syndromes are common among users of anabolic-androgenic steroids (AAS). However, the prevalence, expression, and severity of psychopathology differ among AAS users and remain poorly understood. In this study, we examine the existence of potential clinically coherent psychopathology subgroups, using cluster procedures.
Methods:
A sample of 118 male AAS users and 97 weightlifting nonusers was assessed using the Millon Clinical Multiaxial Inventory-III (MCMI-III), measuring personality disorders and clinical syndromes. Group differences in MCMI-III scales were assessed using Wilcoxon-Mann-Whitney tests and Fisher's exact test. Agglomerative hierarchical clustering was used to identify clusters based on MCMI-III scale scores from the whole sample.
Results:
AAS users displayed significantly higher scores on all personality disorder (except narcissistic) and clinical syndrome scales compared to nonusing weightlifters. The clustering analysis found four separate clusters with different levels and patterns of psychopathology. The "no psychopathology" cluster was most common among nonusing weightlifters, while the three other clusters were more common among AAS users: "severe multipathology," "low multipathology," and "mild externalizing." The "severe multipathology" cluster was found almost exclusively among AAS users. AAS users also displayed the highest scores on drug and alcohol dependence syndromes.
Conclusions:
AAS users in our sample demonstrated greater psychopathology than the nonusing weightlifters, with many exhibiting multipathology. This may pose a significant challenge to clinical care for AAS users, particularly as there appears to be significant variation in psychopathology in this population. Individual psychiatric profiles should be taken into consideration when providing treatment to this group.
Significant outcomes:
As a group, AAS users displayed markedly greater psychopathology than nonusing weightlifters. Multipathology was common among AAS users. Four different subgroups of personality profiles were identified with distinct patterns of pathology and severity.
Limitations:
The cross-sectional nature of the study precludes inferences about causality. The study is limited by possible selection bias, as participants choosing to be involved in research may not be entirely representative for the group as a whole. The study is vulnerable to information bias, as the results are based on self-report measures and interviews.
... AAS use is associated with several side effects, where the extent and severity of health issues seems to depend on AAS type, dose, accumulated time of use, method of administration and unknown predisposing factors [5,6]. Adverse health effects include cardiovascular harm, infertility, gynecomastia, neurocognitive impairment and musculoskeletal damage [5,[7][8][9][10][11][12]. In addition, about 30-50% of people who use AAS develop dependence, characterized by continued AAS use despite adverse physical and mental health effects [13]. ...
Background
Recreational use of anabolic-androgenic steroids (AAS) is a public health concern world-wide associated with a range of physical and psychological side effects. Still, people who use AAS tend to be reluctant to seek treatment. This study aims to explore use characteristics, treatment-seeking behaviour, side effects and associated health concerns among men with AAS use.
Methods
The study includes cross-sectional self-report data from 90 men with a current or previous use of AAS exceeding 12 months, where 41 (45.6%) had sought treatment at least once during their lifetime, and 49 (54.4%) had not. Health service engagement was examined with descriptive statistics on reasons for contacting health services, transparency about AAS use, satisfaction with health services and reasons for not seeking treatment. Furthermore, experienced side effects and health concerns were compared between the treatment seeking and the non-treatment seeking group, using two-sample t-tests and Chi² or Fisher exact tests for numerical and categorical variables, respectively.
Results
All 90 AAS-using men reported side effects from AAS use. Treatment seekers were significantly younger, experienced more side effects including gynecomastia, excessive sweating, fatigue, depression and anxiety, and expressed more concern for testosterone deficiency. Preventive health check-up was the most common reason for seeking treatment (n = 22, 53.7%), and 38 men (93%) were transparent about AAS use during consultations with health professionals. The main reported reasons for not seeking healthcare services were that the experienced side effects were not considered to be of treatment demanding nature (n = 39, 79.6%) and the belief that healthcare providers had scarce knowledge about AAS use and its health impacts (n = 12, 24.5%).
Conclusions
Reluctance to seek treatment among people who use AAS, despite having associated side effects and health concerns, may contribute to continued health risks. It is important to fill the knowledge gap on how to reach and treat this new patient group, and policy makers and treatment providers need to be educated on how to meet their treatment needs.
Introduction:
Non-prescribed anabolic-androgenic steroid (AAS) use is widespread and may induce hypogonadism, and metabolic, cardiovascular and mental health risks. The study aims to explore feasibility and safety of off-label clomiphene citrate therapy, whether the treatment will reduce the symptoms of androgen deficiency, and to study changes in health risks after cessation.
Methods and analysis:
This is a non-randomized proof of concept pilot study to test the feasibility of an off-label hormone intervention. In this open-labeled intervention study, we shall include males with AAS dependence intending to quit AAS use. Clomiphene citrate will be given for a period of 16 weeks to stimulate the endogenous testosterone production. Measures of physical and mental health will be examined from ongoing AAS use, during the intervention period, and at follow-up 6- and 12-months post-cessation.
Change in self-reported symptoms of hypogonadism (fatigue, depression, anxiety, sexual dysfunction) and other withdrawal symptoms will be compared with data from a group of men who ended AAS use temporarily without any medical intervention.
Discussion:
This pilot study is the first study to test feasibility of off-label use of CC with the intention to restart endogenous testosterone production upon cessation of AAS among men with AAS-induced hypogonadism. The study may provide valuable clinical insights, enabling the exploration of whether adjustments are needed for the intervention. The results may be used to determine the sample size and informing the design of future RCTs or case comparison studies.
Ethics and dissemination:
The study is initiated by investigators, funded by public grants and is approved by the Regional Committee for Medical and Health Research Ethics (REC) in Norway, Norwegian Medicines Agency and the Data Protection Officer for Research at Oslo University Hospital.
Trial registration: EudraCT, EudraCT 2020-005938-15, Registered by Norwegian Medicines Agency 3rd November 2021. https://www.clinicaltrialsregister.eu/ctr-search/trial/2020-005938-15/NO
Background:
The usage of androgenic-anabolic steroids (AAS) leads to severe side effects. The aim of our study was to investigate the effects of AAS on the increase in the carotid intima-media thickness which is regarded as predictor of cardiovascular disorders and determine the association of ASS usage to urinary, hepatic, and hematological systems as well as lipid disorders.
Methods:
A total of 60 male bodybuilders (30 AAS users with a mean age of 31.2±8.9 years and 30 AAS nonusers with a mean age of 31.2±8.9 years) were assessed in this cross-sectional study. The patients' demographic, radiologic, hormonal, and biochemical parameters were recorded. The carotid intima-media thickness (CIMT) was measured using B-mode ultrasound in both groups. Abdominal ultrasonography was used to assess for the presence of fatty liver.
Results:
CIMT was significantly increased in AAS (0.72±0.13 mm) users than in the controls (0.47±0.07 mm) (P<0.001). The mean duration of AAS usage was 2.70±2.13 years. There was a statistically significant positive correlation between the duration of AAS usage and CIMT (r=0.710; P<0.001). A statistically significant negative correlation among HDL, LH, and CIMT was found in the correlation analysis between biochemical parameters and CIMT among AAS users (respectively, r and P values were: r=0.399; P=0.029; r=-0.366; P=0.047; r=-0.287; P=0.035). Likewise, a negative correlation (r=-0.425; P=0.019) was found between FSH and CIMT.
Conclusions:
We found that the usage of AAS among male bodybuilders has led to an increase in CIMT, which is associated with poor cardiovascular health. The results of our study highlight the vital importance of educating male bodybuilders who use these chemicals about the side effects.
Aims
To determine associations between anabolic‐androgenic steroid (AAS) use‐related morbidity including cardiovascular disease (CVD) and engagement to health services.
Methods
In this cross‐sectional study, 90 males with at least 12 months cumulative current or former use of AAS were included. The participants were divided into a treatment‐seeking group (TSG) and a non‐treatment seeking group (non‐TSG) based on their responses to a self‐report web questionnaire. All participants were screened for symptoms that could be indicative of CVD through a clinical interview, and examined with blood samples, blood pressure measurements and transthoracic echocardiography.
Results
In the total sample (n = 90), mean age was 39 ± 11 years with cumulative AAS use of 12 ± 9 years. Among men in the TSG with current use there were higher prevalence of dyspnoea (50% vs 7%) and reduced left ventricular ejection fraction (LVEF) in conjunction with left ventricular hypertrophy (LVH) (36 vs. 9%) and/or high blood pressure (55% vs. 19%) compared to men in the non‐TSG. Among men with current AAS use and established LVEF <50% (n = 25) or LVH (n = 21), 44% (11) and 43% (9) respectively, had never engaged health services due to AAS‐related adverse effects. Deviant liver‐ and kidney parameters were frequently observed in the total sample but without between‐group differences.
Conclusions
Treatment‐seeking behavior among current AAS users may be associated with increased levels of dyspnoea and established CVD. Despite objective signs of severe CVD among a substantial amount of study participants, it is of great concern that the majority had never sought treatment for AAS‐related concerns.
